P1702: IMPACT OF CENTER CHARACTERISTICS AND MACROECONOMIC FACTORS ON THE OUTCOME OF ADULT PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA TREATED WITH PEDIATRIC-INSPIRED PROTOCOLS
Authors: P. Barba, M. Morgades, P. Montesinos, J. Gonzalez Campos, A. Torrent, C. Gil, T. Bernal, M. Tormo, S. Mercadal, S. Saumell, I. García-Cadenas, M. Queipo de Llano, M. Cervera, R. Coll, A. Bermudez, M. Amigo, S. Monsalvo, J. Esteve, R. Garcia Boyero, A. Novo, J. Hernandez Rivas, A. Cladera, P. Martinez-Sanchez, J. Serrano, M. T. Artola, B. Soria, E. Abella, F. Vall-Llobera, J. Bergua, P. Herrera, D. Barrios, J. M. Ribera
Journal: HemaSphere (2022)

Background: Several patient and disease characteristics have been identified as prognostic factors for several outcomes in adult patients diagnosed with acute lymphoblastic leukemia (ALL). However, the impact of socio-economic variables on the outcome of adult ALL has been little studied. Aims: To analyze the potential impact of socio-economic variables on the outcome of newly diagnosed ALL in adult patients included in 4 consecutive trials of the Spanish Program for Treatment of Hematological Malignancies (PETHEMA) Group. Methods: Patients with newly diagnosed Philadelphia chromosome (Ph) positive or negative ALL treated within one of 4 consecutive trials of the PETHEMA group from 2003-2018 were included in this study. Patients were treated with risk-adapted pediatric-inspired protocols. Allogeneic stem cell transplantation (allo-SCT) was indicated in all patients with Ph-positive ALL or in those with Ph-negative ALL showing slow clearance of measurable residual disease. Most relevant clinical variables as well as center-, demographic- and economic-related variables (generally named as socio-economic variables) were collected for all patients. A univariable and multivariable analyses (MVA) adjusted for relevant clinical variables were conducted to assess the impact of socio-economic variables on several outcomes. Collinearity among socio-economic variables was taken into account in the analysis. Results: 830 ALL adult patients were treated in 59 centers during the study period and were enrolled in the study. Patients were included in protocols HR-03 (n=326, 39%), IR-08 (n=89, 11%), HR-11 (n=283, 34%) and PH-08 (n=132, 16%). Two-hundred and twenty-six patients (38% of the evaluable patients) received allo-SCT in first CR, according to treatment protocols. Main characteristics of patients at diagnosis as well as socio-economic variable distribution are summarized in Table 1. Probability of CR ranged from 87% in the HR-03 to 96% in the IR-08 and PH-08 trials. Cumulative incidence of relapse (CIR) at 5 years among the 752 patients who achieved complete remission was 41% (95%CI 37-45). In the MVA adjusted model for socio-economic variables, the only variable associated with a higher CIR was a higher number of inhabitants in the city where the treatment center was located (HR 1.40 [95%CI 1.08- 1.8], p=0.01). High WBC at diagnosis and Ph-negative ALL were also associated with higher CIR. Probability of DFS and OS at 5 years for the whole cohort was 43% (95%CI 39-47) and 46% (95%CI 42-50), respectively. In the MVA adjusted model for socio-economic variables, none of them were associated with a lower PFS or OS. ECOG PS> 1, higher WBC at diagnosis, Ph negative ALL were associated with lower PFS. These three variables and older age and earlier ALL diagnosis were associated with lower OS. Regarding toxicity, cumulative incidence of treatment-related mortality (TRM) (including transplant-TRM) at 5 years was 17% (95% CI 14-20). Variables associated with higher TRM were older age, Ph negative ALL and earlier diagnosis. None of the socio-economic variables was associated with higher TRM in the MVA adjusted. Image:Summary/Conclusion: Socio-economic variables do not seem to have an impact on outcomes in newly diagnosed adult patients with ALL in the setting of a public health system with clearly defined and structured treatment protocols. Based on our results, these protocols can be administered to ALL patients in all hospitals adhered to a PETHEMA cooperative ALL group.